The Treatment Experience, Burden, and Unmet Needs (TRIBUNE) study is a cross-sectional observational study of the cost of MS in Canada and five European countries. According to the Canadian estimate, the mean annual cost was $30,836 per MS patient with mild disability (EDSS < 3), $46,622 per patient with moderate disability (EDSS 4-6.5), and $77,981 per patient with severe disability (EDSS score 7-9) (Karampampa et al. J Popul Ther Clin Pharmacol 2012;19:e11-25; free full text at www.jptcp.com/jptcp11072e11_e25_karampampa-pdf-r180364).     The estimated cost per relapse for an RRMS patient (EDSS < 5) was $10,512.